Provider Demographics
NPI:1568716413
Name:PHAN, THANH HUONG (RPH)
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:HUONG
Last Name:PHAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2936 SANTA MARIA DR
Mailing Address - Street 2:
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19525-9322
Mailing Address - Country:US
Mailing Address - Phone:484-802-0114
Mailing Address - Fax:
Practice Address - Street 1:2101 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4808
Practice Address - Country:US
Practice Address - Phone:717-843-0197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP041614L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist